Mental health and Aboriginal people and communities

10-year mental health plan technical paper

Contents

Background...... 1 Aboriginal communities and the experience of poor mental health...... 2 Policy and program options...... 3 Improve access to culturally responsive mainstream clinical treatment and support services...... 3 Improve mental health of Aboriginal prisoners...... 4 Improve access to stable, appropriate and affordable housing...... 4 Questions for consultation...... 4 References...... 5

experienced across generations. This intergenerational Background trauma is a compounded by increased rates of incarceration and child protection intervention, which Victoria’s Aboriginal population is estimated to be replicate institutionalised family separation. 47,333 people, and forms 0.86 per cent of the total Victorian population. The Aboriginal Victorian The history of Aboriginal Victorians is also a history of population is young. Just under half (47 per cent) are resistance, reclamation of rights, and community and under 19 years of age (Australian Bureau of Statistics personal resilience. It is a history that seeks to re- 2011). The Aboriginal Victorian population is growing, establish self-determination, in all aspects of and growing much faster than the non-Aboriginal community and including the ways in which Aboriginal population. Just over half of Victoria’s Aboriginal people and community access and interact with population lives in rural and regional areas (53 per government. cent) (cited in VicHealth 2011). As a result many Aboriginal people enjoy excellent Victoria’s first peoples draw on shared culture that social and emotional wellbeing. Many Aboriginal extends tens of thousands of years in the past, and families and communities thrive. But some do not. continues to be practiced now. This culture sees health Aboriginal people and communities are more likely to as not simply the physical wellbeing of an individual, face risk factors for poor mental health and barriers to but the social, emotional and cultural wellbeing of the emotional and social wellbeing than the general whole community. population. This paper examines the experience of poor social and emotional wellbeing and mental health Victoria’s first peoples also share a more recent history in Aboriginal communities, and the role that social, of colonisation, dispossession and cultural dislocation economic and cultural determinants of mental health and separation from family and community through have in contributing to this experience of poor mental removal and denial of political power. health. Within living memory, Aboriginal Victorians were Mental illness is estimated to contribute to 15 per cent forcibly removed from their families under Stolen of the burden of disease for Aboriginal Australians Generation policies, with 47 per cent of Aboriginal (compared with 13 per cent of total Australian Victorians having a relative that was removed under population). This is second only to cardiovascular these policies. In itself this represents trauma that is disease, which accounts for 17 per cent of the burden disorders (19 per cent); stress-related disorders (18 per of disease for Aboriginal Australians (Vos et al. 2007). cent), followed by substance abuse related disorders (8 per cent) (Department of Health and Human Services 2013–14). Aboriginal communities and Nationally, Aboriginal men are over four times more the experience of poor likely, and Aboriginal women over three times more likely, than expected for their proportion of the mental health population to be hospitalised for ‘mental disorders attributable to psychoactive substance misuse’ than their non-Aboriginal counterparts (Purdie et al. 2010). Aboriginal Victorians report higher rates of psychological distress, and have higher rates of suicide Many Aboriginal people and communities face and self-harm than the general population. Aboriginal continuing social and economic inequity. This includes Victorians are also more likely to experience social and higher rates social exclusion, institutionalised racism economic circumstances that contribute to and and discrimination, as well as high rates of exacerbate the experience of poor mental health. unemployment, lower income, poorer housing and traumatic experience. These factors are closely linked In a 2012–13 survey, 30 per cent of Aboriginal people to physical and mental health and increase the surveyed reported high or very high psychological probability of psychological distress and mental health distress levels, which was nearly three times the rate problems. We also know that these conditions have a reported by non-Aboriginal people (Australian Bureau particular and lasting effect on the future social and of Statistics 2014). emotional wellbeing of children, and that Aboriginal The national rate of suicide in the Aboriginal population children by extension have an increased likelihood of is estimated to be between two and three times higher vulnerability to poor mental health. than the rate in the non-Aboriginal population A survey undertaken by VicHealth of 755 Aboriginal (Department of Health 2010). Suicide was the most Victorians in two rural and two metropolitan areas in common cause of alcohol-related deaths among Victoria found that 97 per cent of those surveyed has Aboriginal males and the fourth most common cause experienced racism in the previous 12 months. among Aboriginal females (cited in Wilkes et al. 2010). Evidence indicates racism is associated with poorer Rates of intentional self-harm among young Aboriginal mental health and reducing incidents of racism can people aged 15–24 years are 5.2 times the rate of non- reduce the risk of a person developing a mental illness, Aboriginal young people (Australian Bureau of particularly depression and anxiety. Individual coping Statistics 2014). strategies, however, did not appear to provide In 2013–14, a total of 1,308 people who identified as adequate protection from harm, indicating the need for Aboriginal or Torres Strait Islander received treatment organisational and community interventions are needed and care from a public clinical mental health service. to reduce racism (VicHealth 2012). This equated to 2 per cent of all clients (Department of Research indicates that people who lack job security or Health & Human Services 2014). experience frequent or extended periods of The majority of Aboriginal people receiving treatment in unemployment report the lowest levels of self-rated a public clinical mental health service were aged 18–64 health and subjective wellbeing. In respect to economic years (77 per cent, compared with 71 per cent of non- disadvantage, Aboriginal people of working age Aboriginal clients in that age group). For children and experience a high level of unemployment – 15.8 per young people, 20 per cent were Aboriginal (compared cent of Aboriginal Victorian’s in the labour market were with 14 per of non-Aboriginal clients in that age group) unemployed in 2006, compared with 5.4 per cent of the and for older people, 3 per cent were Aboriginal overall Victorian population (Department of Human (compared with 15 per cent of non-Aboriginal clients in Services 2008). that age group) (Department of Health and Human Aboriginal Australians experience homelessness at four Services 2014). times the rate of non-Aboriginal Australians (Australian The most prevalent disorders experienced by Institute of Health and Welfare 2011). We know that Aboriginal people who were clients of a public clinical homeless and housing instability contributes to an mental health service were schizophrenia and increased risk of mental illness and makes it harder to delusional disorders (21 per cent); mood (affective) manage existing poor mental health. We know that adverse conditions in early life are Improve access to culturally associated with higher risk of mental disorders. Social responsive mainstream clinical and economic disadvantage (including treatment and support services intergenerational poverty) places children and young Aboriginal people at greater risk of behavioural and This option focuses on how the different parts of the environmental problems (for example, exposure to specialist mental health service system can work with racism and family and household factors such as Aboriginal Community Controlled Health Organisations exposure to violence, poor-quality parenting and having and other key stakeholders towards a common set of lived in five or more homes) that affect mental health as priorities, and how resources can be targeted towards well as physical health and encourage self-harm and activities proven to result in improved access and the self-destructive tendencies. Available data shows an best mental health outcomes for Aboriginal people. overall picture of pronounced and increasingly poor This could include: mental health and social and emotional wellbeing of children and young Aboriginal people (Parker and • identifying key gaps, issues and good practice in the Milroy 2014). provision of treatment and support interventions for Aboriginal people experiencing severe mental Aboriginal people comprise 7.8 per cent of the Victorian illness and their families prison population, despite accounting for less than 1 • identifying a cohesive set of strategies, including per cent of the Victorian population. Young Aboriginal system redesign and service development, needed people are disproportionally represented in the juvenile to improve Aboriginal peoples’ access to timely, justice system (Justice Health and Corrections Victoria culturally sensitive and culturally safe clinical mental 2015). health treatment, with the focus on early intervention A study into Aboriginal prisoner mental health and in the illness pathway and episode and suicide cognitive function found that across their lives prevention. These strategies would take into Aboriginal prisoners, particularly female prisoners, are account government investment in mental health exposed to high rates of social adversity, trauma and support services for Aboriginal people and health problems. The study found that 72 per cent of opportunities for a more joined up approach with the men and 92 per cent of women had received a lifetime corrections/justice system and other key social diagnosis of mental illness, compared with a lifetime support services prevalence of 45 per cent in the general population. • monitoring and report achievement of Mental Health The rates of all disorder, including psychotic illnesses, Community Support Services1 program in improving were dramatically higher than those found in the outcomes for Aboriginal people aged 16–64 years general community in Victoria. For both males and living with a psychiatric disability, and identifying females, the most prevalent illnesses included major further action required to optimise outcomes for depressive episodes and post-traumatic stress disorder Aboriginal people with a psychiatric disability in the (Ogloff et al. 2013). lead up to the introduction of the National Disability Insurance Scheme • identifying action required to facilitate participation in Policy and program options the National Disability Insurance Scheme for eligible Aboriginal people Mental health for Aboriginal people and communities is • the need for new culturally appropriate indicators to not just about individual wellbeing and effective health monitor improved responsiveness, including care. Addressing entrenched disadvantage and modification of the planned consumer mental health inequity is equally significant to improve the Your Experience of Service survey to ensure it is disproportionate experience of poor mental health culturally appropriate and fit for purpose. among Aboriginal people. And given the legacy of institutional injustice, how governments work with Particular attention could be given to: Aboriginal communities is as important as what actions governments take to improve mental health outcomes • the needs of children, adolescents and young for Aboriginal people and communities. people, given growth in this demographic group

1 Previously called the Psychiatric Disability Rehabilitation and Support Services (PDRSS) program, this program provides psychosocial rehabilitation support to adults 16–64 years with a mental illness and psychiatric disability. within the Aboriginal population and the heightened Improve access to stable, vulnerability of these population groups appropriate and affordable • Aboriginal people with mental health problems housing engaged in the criminal justice system (focus on diversion and pre- and post-transition support) The impact of unaddressed homelessness and insecure housing among people with a severe mental • inter-relationship between poor mental health, family illness has significant social and economic dimensions violence and vulnerable children that are broader than health. A common policy • inter-relationship between mental health and response across housing, homelessness and mental physical health (for example diabetes and obesity) health portfolios is therefore critical if improved health, • co-occurring alcohol and substance misuse, social and economic outcomes are to be achieved for including impact of growing use of poly-drug misuse people with a severe mental illness. The housing needs within the Aboriginal community of Aboriginal people with a severe mental illness and • reducing homelessness among Aboriginal people their families should be given priority, given the experiencing mental illness and dual diagnosis, disproportionate level of homelessness experienced by drawing on the findings of National Partnership this population group. Agreement on National Mental Health Reform initiatives that prioritised Aboriginal people experiencing homelessness and housing risk Questions for consultation • suicide prevention. This work should take into account the risk factors that 1. Are the key barriers to good mental health and contribute to psychological distress and mental illness disadvantage associated with poor mental health (for example adverse childhood experiences and for Aboriginal communities and people adequately trauma) and the social and economic factors that described? How else can this be understood? increase or exacerbate mental health problems and 2. Are there particular outcomes that we should focus influence overall health and wellbeing (for example effort on for Aboriginal people and communities? poverty and unemployment, homelessness and housing insecurity, family breakdown and 3. How can we improve these outcomes for disengagement from social supports, engagement with Aboriginal people and communities (given what we corrections, and co-existing alcohol and drug misuse know about the barriers and harms experienced by problems). Aboriginal people and communities)? What do we know works? Improve mental health of Aboriginal 4. Do the options for consideration focus effort where prisoners it is most needed and most effective? Are there other options that should also be considered? Incarceration comes at a high cost through exposure to harsh prison environment, marginalisation, poor health 5. How do we integrate mental health programs outcomes and impact on employment opportunities. generally or programs focused on Aboriginal Research has found that a person’s contact with or people and community in particular into a system progression through the justice systems can be of care? reduced through diversion programs. However, Aboriginal Australians have lower participation and completion rates of diversion programs – particularly for those who access mainstream programs. As identified by the Victorian Government’s recently released Justice Health and Corrections Aboriginal social and emotional wellbeing plan, key areas for consideration include pre- and post-transitional release programs for Aboriginal women and men, and strategies to strengthen the cultural competency of the prison workforce. Consideration should also be given to integrated diversionary strategies for keeping Aboriginal women and men out of prison. Parker R and Milroy H 2014, ‘Mental illness in References Aboriginal and Torres Strait Islander peoples’, in Purdie et al. (eds), Working together: Aboriginal and Torres Australian Bureau of Statistics 2011, Census: Strait Islander mental health and wellbeing principles Australian demographic statistics, 3101.0, Australian and practice. 2nd ed., Commonwealth Government of Bureau of Statistics, Canberra. Australia, Canberra. VicHealth 2011, Aboriginal health in Victoria: research Justice Health and Corrections Victoria 2015, summary, State Government of Victoria, Melbourne. Aboriginal social and emotional wellbeing plan, State Vos T, Barker B, Stanley L, Lopez A 2007, The burden Government of Victoria, Melbourne. of disease and injury in Aboriginal and Torres Strait Ogloff RP, Patterson J, Cutajar M, Adams K, Thomas S Islander peoples, University of Queensland, Brisbane. and Halacas C 2013, Koori prisoner mental health and Australian Bureau of Statistics 2014, Australian and cognitive function study, Monash University, prepared Torres Strait Island health survey: first results, Australia for the Department of Justice, State Government of 2012–13, 4727.0.55.001, Australian Bureau of Victoria, Melbourne. Statistics, Canberra. Department of Health 2010, Victorian Aboriginal suicide prevention and response action plan 2010-2015, State To receive this publication in an accessible Government of Victoria, Melbourne. format phone (03) 9096 8281 using the Wilkes E, Gray D, Saggers S, Casey W and Stearne A National Relay Service 13 36 77 if required, 2010, ‘Substance misuse and mental health among or email [email protected] Aboriginal Australians’, in Purdie et al. (eds), Working Authorised and published by the Victorian together: Aboriginal and Torres Strait Islander mental Government, 1 Treasury Place, Melbourne. health and wellbeing principles and practice, 2nd ed., Commonwealth Government of Australia, Canberra. © State of Victoria, Department of Health & Human Services August, 2015. Department of Health & Human Services 2014, CMI- ODS administrative data 2013–14, unpublished, State Where the term ‘Aboriginal’ is used it refers to both Government of Victoria, Melbourne. Aboriginal and Torres Strait Islander people. Indigenous is retained when it is part of the title of a Purdie N, Dudgeon P and Walker R (eds) 2010, report, program or quotation. Working together: Aboriginal and Torres Strait Islander mental health and wellbeing principles and practice, Available at www.mentalhealthplan.vic.gov.au Commonwealth Government of Australia, Canberra. VicHealth 2012, ‘Mental health impacts of racial discrimination in Victorian Aboriginal communities’, Experiences of racism survey, State Government of Victoria, Melbourne. Department of Human Services 2008, Are we there yet: indicators of inequality in health, State Government of Victoria, Melbourne. Australian Institute of Health and Welfare 2011, A profile of homelessness for Aboriginal and Torres Strait Islander people, cat. no. IHW 43, Australian Institute of Health and Welfare Canberra.